前哨淋巴结绘图在子宫内膜癌手术中的应用  

Application of methylene blue sentinel lymph node mapping in endometrial cancer

作　　者：周莉[1] 王首寒 袁勇[1] 孙小单[1] Zhou Li Wang Shouhan Yuan Yong Sun Xiaodan(Department Two of Gynecologic Oncology Department Three of Abdominal Oncology, Jilin Province Tumor Hospital, Changchun 130012, China)

机构地区：[1]吉林省肿瘤医院妇科肿瘤二科,长春130012 [2]吉林省肿瘤医院腹部肿瘤外三科,长春130012

出　　处：《中华腔镜外科杂志（电子版）》2016年第5期273-276,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：吉林省卫生科研计划临床应用研究(2013S029)

摘　　要：目的探讨亚甲蓝示踪前哨淋巴结(SLN)绘图在子宫内膜癌手术中的应用价值。方法67例子宫内膜癌患者行(广泛)全子宫+双附件切除+盆腔±腹主动脉旁淋巴结清扫术,术前2 h于宫颈3、6、9、12点钟位置注射亚甲蓝,术中识别并记录蓝染SLN的部位、数量。术后所有淋巴结经苏木精-伊红染色及免疫组化病理学检查。结果 67例患者中腹腔镜手术53例,机器人手术14例。总体及双侧盆腔SLN检出率分别为82.0%(55/67)及71.6%(48/67),灵敏度87.5%(7/8),假阴性率12.5%(1/8)。切除SLN、盆腔淋巴结、腹主动脉旁淋巴结的中位数分别为2、7、0枚。SLN集中分布于闭孔窝及髂外血管周围。结论亚甲蓝示踪SLN绘图具有灵敏度高、操作简便的优点,可作为子宫内膜癌手术中预测盆腔淋巴结转移情况的常规方法。Objective To investigate the value of methylene blue sentinel lymph node（ SLN） mapping in endometrial cancer. Methods 67 patients of endometrial cancer underwent radical or total hysterectomy ＋oophorectomy and pelvic ± para-aortic lymphadenectomy. The methylene blue dye was injected to the cervix at4 locations（ 3,6,9 and 12 o＇clock） 2 hours before the operation. The number of sentinel lymph node and locations were observed and recorded during the operation. All of the lymph nodes were analyzed by hematoxylin and eosin and immunohistochemistry. Results Of 67 patients,53 cases underwent laparoscopic operation and 14 underwent robotic operation. Overall and bilateral detection rates were 82. 0%（ 55 /67） and 71. 6%（ 48 /67）,respectively,the sensitivity was 87. 5%（ 7 /8）,the false negative rate was 12. 5%（ 1 /8）. The median number of removed SLNs,pelvic lymph node and para-aortic lymph node was 2,7,0,respectively. The anatomic distribution of SLN were mostly in obturator fossa and external iliac artery. Conclusions Sentinel lymph node mapping with high sensitivity and simple operation,can be used as conventional method of surgery for endometrial cancer predicting the overall situation of pelvic lymph node metastasis.

关 键 词：子宫内膜癌 前哨淋巴结 亚甲蓝 淋巴绘图 

分 类 号：R737.33[医药卫生—肿瘤]